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Abstract

Background—Catheter ablation has become an established treatment modality for a broad spectrum of ventricular tachycardias (VTs). We analyzed incidence and predictors of major complications of VT ablation procedures in a high-volume, expert center.

Methods and Results—We evaluated 548 consecutive patients who underwent 722 ablation procedures, 473 (65.5%) for structural heart disease (SHD) VT, in the period 2006-2012. There were 45 (6.2%) major complications observed in 44 patients. Access site vascular complications were the most frequent (3.6%). Three patients (0.4%) had cardiac tamponade/hemopericardium and five patients (0.7%) had a thromboembolic event. No procedural deaths occurred. Procedures for SHD-VT vs. idiopathic VT had a significantly higher complication rate (8.0% vs. 2.8%, p=0.006). Similarly, patients with electrical storm (10.1% vs. 5.3%, p=0.04) and non-elective procedures (8.4% vs. 3.5%, p=0.007) were at higher risk of complications. On multivariate analysis, age >70 years (p=0.01), serum creatinine >115 μM/L (p=0.0003) and individual operator (p=0.0001) were the only independent predictors of complications. Overall 30-day mortality in the SHD-VT group reached 5.0% (patients) and 3.6% (procedures). Death was associated with early recurrence of VT/ventricular fibrillation (VF) (p=0.003) and ablation for electrical storm (p=0.02).

Conclusions—Complication rates for VT ablation are significantly lower in idiopathic VT and/or in elective procedures. Independent predictors of complications include age, renal insufficiency and individual operator. Post-procedural mortality is predicted by early recurrence of VT/VF and ablation for electrical storm.